Editors’ Note: In this article, the word “female” is used as an adjective and “women” as a noun by convention but without the intention of conflating sex and gender. The author and editors recognize that these words, as colloquially used, do not accurately reflect distinctions between gender and sex or depict how individuals identify their gender.
Explore This IssueACEP Now: Vol 40 – No 03 – March 2021
When you think about “women in medicine,” whose faces do you see? Whose voices are represented? Who sits at the leadership table? As I near the end of residency training, I want to reflect critically on the importance of appreciating the diversity within women in medicine rather than viewing the group as homogeneous, with individuals having approximately the same goals and needs.
In 2019, an article was published in a major emergency medicine journal entitled, “Does Physician Gender Have a Significant Impact on First-Pass Success Rate of Emergency Endotracheal Intubation?” There was, unsurprisingly, no significant difference between the first-pass success rates of female and male physicians.
The manuscript sparked shock, anger, and surprise within my community of female emergency physicians. We immediately questioned the premise of the article and felt offended that the research group was even asking the question. And we were not alone: Med Twitter blew up with vitriol, and there were enough complaints that the paper was retracted soon after publication. However, in hindsight, the paper reflected something that many of us in the United States had not thought to consider: Though we have a long way to go here, there are parts of the world where barriers to achieving gender parity in medicine are far greater. A study that might initially strike us as offensive may have actually been a necessary one to counter negative stereotypes about women’s professional abilities.
The study in question was conducted in South Korea, where female physicians are in the minority. The research group had intended to “confirm that there is no physician gender effect on the first pass success rate,” as the corresponding author tweeted, which could have potentially helped establish female physicians as equally effective proceduralists in a predominantly male field. Only after my initial negative reaction to the manuscript, and after it was retracted, did I consider the local cultural context of clinical practice in the study site. It contrasts with my own—I work at a renowned academic hospital where our leading airway expert is a female physician and where our faculty and residents generally expect that male and female physicians perform equally.
In qualitative and ethnographic research—my areas as a medical anthropologist—we have a principle called “reflexivity,” the deliberate examination of how one’s own identity and values influence the research process. Standard qualitative results reporting guidelines include an expectation that manuscripts address reflexivity. The first author of the retracted paper was a female medical student. The corresponding author wrote about raising daughters and believing in women’s potential in what amounted to an apology letter for upsetting the international community of physicians. Would a statement in the manuscript about reflexivity have helped frame the study? Did the journal’s reviewers consider how the study might be received internationally and accordingly advise the authors? Was there an opportunity for the editors to contextualize the paper rather than retract it?
Context matters. Women’s experiences practicing medicine vary all over the world. Despite the inequalities in daily interactions, promotion, and pay that female physicians continue to face in the United States, we do have advantages compared to female physicians in many other countries.
We are making progress, but women in medicine are not a monolith, either in the United States or elsewhere. If we fail to see that, we’ll be hindered in our efforts to advance women’s medical careers and professional opportunities. This example made me think about challenges closer to home.